Sažetak | Uvod: SLE i SSc su učestalije u žena generativne dobi što upućuje da spolni hormoni imaju
značajnu ulogu u patogenezi, pojavnosti i kliničkom tijeku ovih bolesti.
Cilj: Ispitati razine spolnih hormona (testosterona, DHEA, androstendiona, estradiola) u postmenopauzalnih
bolesnica sa SLE-om i SSc-om u odnosu na zdrave žene u post-menopauzi.
Utvrditi povezanost ispitivanih hormona s aktivnošću SSc-e i SLE-a. Istražiti povezanost
specifičnih protutijela: ANA, anti-Scl70, ACA, anti-dsDNA i anti-Ro protutijelima s razinama
ispitivanih spolnih hormona.
Metode: U ovom istraživanju je uključeno 27 bolesnica sa SSc-om, 27 bolesnica sa SLE-om i
27 zdravih žena u post-menopauzi. Razine spolnih hormona su određivane u svih ispitanika
RIA (radioimunoesej) metodom. U bolesnica sa SSc-om su određivana ANA, ACA i anti-
Scl70 protutijela, a u bolesnica sa SLE-om ANA, anti-dsDNA i anti-Ro protutijela. Aktivnost
SSc-e je određivana korištenjem EUSTAR SSc „Activity Score“, a SLE-a pomoću SLEDAI
indeksa.
Rezultati: U bolesnica sa SLE-om su nađene značajno niže razine testosterona (0,60±0,52
nmol/L v. 1,64±1,02 nmol/l, p<0,001) i DHEAS (0,78±0,92μmol/L v. 2,00±1,08 μmol/L,
p<0,001) u odnosu na zdrave ispitanice. Nije zabilježena značajna razlika u razinama
androstendiona (4,54±2,59 nmol/L v. 5,79±2,82 nmol/L, p=0,244) i estradiola (0,20±0,09 v.
0,16±0,06 nmol/L, p=0,250) ispitivanih skupina. Vrijednosti testosterona su negativno
korelirale s aktivnošću bolesti izraženom sa SLEDAI indeksom (r=-0,381, p=0,049).
Testosteron (r=-0,560, p=0,002), DHEAS (r=-0,563, p=0,002) i androstendion (r=-0,396;
p=0,041) su negativno korelirale s ANA protutijelima. Estradiol je pozitivno korelirao s antidsDNA
protutijelima (r=0,398, p=0,40). Razine testosterona (r=-0,453, p= 0,018) i DHEAS
(r=-0,480, p=0,011) su negativno korelirale s anti-Ro protutijelima. U bolesnica sa SSc-om su
nađene značajno niže razine testosterona (0,80± 0,62 nmol/L v. 1,64±1,02 nmol/l, p<0,001)
DHEAS (1,16±1,00 μmol/L v. 2,00±1,08 μmol/L, p=0,008) i androstendiona (3,26±3,08
nmol/L v. 5,79±2,82 nmol/L, p=0,004) u odnosu na zdrave ispitanice. Nije zabilježena
značajna razlika u razinama estadiola (0,18±0,84 v. 0,16±0,06 nmol/L, p=0,250) ispitivanih
skupina. Razine androstendiona su negativno korelirale s razinom ACA (r=-0,434, p=0,024)
protutijela, dok je nađena pozitivna korelacija s anti-Scl70 protutijelima (r=0,385, p=0,047).
Razine testosterona su pozitivno korelirale s anti-Scl70 protutijelima (r=0,489, p=0,010).
Ispitivani hormoni nisu pokazali povezanost s aktivnošću bolesti.
Zaključak: Razine testosterone i DHEAS su smanjenje u post-menopauzalnih žena sa SLEom
i SSc-om u usporedbi sa zdravim post-menopauzalnim ženama. Pozitivna korelacija
androgena sa anti-Scl70 protutijelima i negativna korelacija s ACA protutijelima otvara
pitanje uloge ovih hormona u SSc-i. Negativna korelacija androgena s anti- Ro i ANA
protutijelima te aktivnošću bolesti potvrđuje dosadašnje spoznaje o protektivnom učinku ovih
hormona u autimunim procesima. Pozitivna korelacija estrogena s anti-dsDNA protutijelima
podržava spoznaje o poticanju humoralne imunosti. |
Sažetak (engleski) | Background: Systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) are more
common in women suggesting that female sex hormones play an important role in the
pathogenesis and clinical aspects of these diseases.
Objective: The aim of this study was to investigate the serum levels of estradiol, testosterone,
dehydroepiandrosterone sulphate (DHEAS) and androstenedione in pos-tmenopausal SLE and
SSc patients in compration with healthy women. The aim was also to examine the possible
correlation sex hormones with diseases activity in SLE and SSc and correlation sex hormones
with specific autoantibodies:antinuclear antibodies (ANA), anticentromeric antibodies (ACA)
and DNA topoisomerase I antibodies (anti-Scl70), anti- double strand deoxyribonucleic acid
antibodies (anti- dsDNA) and anti-Ro antibodies in SLE and SSc patients.
Methods: Twenty-seven post-menopausal SSc patients, twenty-seven post-menopausal SLE
patients and twenty-seven healhty women were enroled in the study. Serum levels of
testosterone, DHEAS, androstenedione and estradiol were measured in all groups. Serum
levels of ANA, ACA and anti-Scl70 were measured only in SSc patients, while in SLE
patients were measured ANA, anti-dsDNA and anti-Ro antibodies. SSc activity was
determined using EUSTAR (European Scleroderma Trial and Research) Systemic Sclerosis
Activity Score, whereas in SLE patients was determined using Systemic Lupus
Erythematosus Disease Activity Index (SLEDAI).
Results: Serum levels of testosterone (0.64±0.56 nmol/L v. 1.64±1.02 nmol/l, p<0.001) and
DHEAS (0.78±0.92μmol/L v. 2.00±1.08 μmol/L, p<0.001) were significantly lower in SLE
patients compared to controls. There wasn't a significant difference in serum levels of
androstendione (4.54±2.59 nmol/L v. 5.79±2.82 nmol/L, p=0.244) and estradiol (0.20±0.09 v.
0.16±0.06 nmol/L, p=0.250) between groups. Serum levels of testosterone negatively
correlated with SLEDAI (r=-0.3809, p=0.049). Testosterone (r=-0.560, p=0.002), DHEAS
(r=-0.563, p=0.002) and androstendione (r=-0.396, p=0.041) negatively correlated with ANA
antibodies. Estradiol positivly correlated with anti-dsDNA antibodies (r=0.398, p=0.40).
Testosterone (r=-0.453, p= 0.018) and DHEAS (r=-0.480, p=0.011) negatively correlated with
anti- Ro antibodies. Serum levels of testosterone (0.80± 0.62 nmol/L v. 1.64±1.02 nmol/l,
p<0.001), DHEAS (1.16±1.00 μmol/L v. 2.00±1.08 μmol/L, p=0.008) and androstenedione
(3.26±3.08 nmol/L v. 5.79±2.82 nmol/L, p=0.004) were significantly lower in SSc patients
compared to controls. There wasn't a significant difference in serum levels of estradiol
between groups (0.18±0.84 v. 0.16±0.06 nmol/L, p=0.250). Serum levels of androstenedione
negatively correlated with ACA antibodies (r=-0.434, p=0.024) while a positive correlation
was found with anti-Scl70 antibodies (r=0.385, p=0.047). Testosterone levels positively
correlated with anti-Scl70 antibodies (r=0.489, p=0.010).
Conclusion: Circulating testosterone and DHEAS levels are decreased in post-menopausal
SLE and SSc patients compared with healthy post-menopausal women. A positive
correlation of androgens with anti-Scl70 antibodies and a negative correlation with ACA
antibodies raise the question of the role of these hormones in the disease. A negative
correlation of androgens with ANA and anti-Ro antibodies as well as SLEDAI confirms
current knowledge about protective effect of these hormones in autoimmune diseases.
Positive correlation of estrogenes with anti- dsDNA antibodies supports the findings of
stimulating humoral immunity. |